Hai-yan CUI

Shanghai Ninth People's Hospital,Shanghai JiaoTong University

KEY WORDS Facial injection beauty；Future “未來”Design Method；complication

About facial filler injection in Asians.We should know the following points.

1.Aest hetics Assessment of Facial Injection Beauty.

2.Overall Design and Solutions of facial injection beauty.

3.Future “未來”Design Method of Facial injection beauty.

4.Three levels of Facial injection beauty.

5.How to prevent and resolve complications，The best treatment for complications is prevention.

Section I Aesthetics and Assessment of Facial Injection Beauty

For the aesthetic of the face,the aesthetic standards of the East and the West are not exactly the same due to differences in ethnic and regional cultures.Westerners have clear facial outlines,narrow cheekbones,threedimensional structures,obvious light and shadow effects,rough skin texture,skin relaxation,and lack of elasticity.The Oriental face is full,the cheekbones complex is large,lacks clear outlines,and the contrast between light and darkness is not clear.The skin is delicate and elastic.Westerners mainly need faces to rejuvenate and resist aging.They need to fill and lift,while Orientals focus on filling and profile shaping.

However,whether it is the East or the West,and regardless of ethnic and cultural differences,the classical formal aesthetic principles are common.Including:symmetry,equilibrium,proportion(golden section as shown in Figure 1-1),coordination,unity of diversity,rhythm etc.In addition to the principles of formal aesthetics,we can also summarize the following points from the evaluation of artistic and emotional:1.Elegant temperament,2.a slender figure,3.Good face,4.Long and graceful neck as noble as a swan,5,charming breast,6,dynamic waist like a dancer,7,round and sex buttocks.When we describe these words,even if we do not see the person,we can imagine the beauty of the person.The highest realm of facial filler injection should be regarded as artistic creation under medical restrictions.Then doctors who do not understand the aesthetic are also difficult to do injection beauty.It is obvious that injection beauty is not a simple inject filler,If we use injection beauty as a work of art,it is not easy.

Fig.1-1

Figure 1-2 Arthur Swift,a Canadian plastic surgeon,has studied the gold ratio.The green line is the baseline X,the blue line is 1.618 X,the black line is 0.618 X,the orange line is 0.382 X,and all the same color lines are the same length.1.618,0.618,and 0.382 are all gold ratios,and there are gold ratios between various lines.Therefore,it shows that proportional aesthetics is an important feature of beauty and occupies an important position in formal aesthetics.

Fig.1-2

Section II Overall Design and Solutions of facial injection beauty.

I published an article in 2007,Putting forward the concept of overall design and creation body aesthetic image.

The concept of overall design and creation of human body aesthetic image includes:systematic overall design and aesthetic evaluation before surgery,psychological counseling during peri-operative treatment,and the comprehensive use of multiple treatment methods.After the surgery,makeup,clothing,modeling,etiquette training and appropriate intervention in the social survival state is a necessary complement,so as to create a beautiful image full of charm and vitality .

If we regard facial injection beauty as artistic creation under medical restrictions,then the creation of beauty can not be simply achieved by a single technology,a treatment method,but should be systematic and holistic design.We have done a retrospective survey,according to the VAS evaluation method,found that the satisfaction of simply receiving a treatment is far lower than that of a systematic overall design.

In the past,the medical model was a simple biomedical model.Now it is a bio-psycho-social medicine model,that is to say,even if an operation is performed well,it only accounts for about 30 %.It also needs to take into account the influence of psychological and social factors of cosmetic doctors.This is particularly evident in the area of cosmetic surgery.

Injection beauty should also follow the principle of a systematic overall design.We have always emphasized that technology is just the most basic and necessary quality for doctors.It can only solve the most basic problems.But more important is the aesthetic,to know what is beautiful,how to give a successful evaluation?

Some cosmetic patients are not satisfied after the injection,for example,A patient originally intended to resolve nasolabial fold,after the injection,the nasolabial fold became flat,but the face looks fatter,of course the patient was unhappy,why? Here is the question of aesthetics,We neglected the relationship between the part and the whole.Therefore,it is particularly important to improve the aesthetic art cultivation and humanistic care spirit of doctors.Especially for cosmetic surgeons as Canadian Dr.Trudeau says:Sometimes to heal,often to help,always to comfort.

Before performing cosmetic injection,we must pay attention to the overall design and construction of human aesthetic image.It can bring better physical vision,psychological satisfaction and social recognition to the patients.Modern medical model emphasizes the role of social and psychological factors in treatment.The doctor should take care of the patients psychological state throughout treatment.

Section III Dr,Cui“未來”Design Method of Facial injection beauty.

When we master the concept of the overall design creation of human body aesthetic image,how do we find a simple and effective way to express the concept.Let the various levels of doctors can easily understand and to use? According to our teaching and training experience,I have summed up and found that the Chinese word “未來” as the most appropriate method of facial aesthetic evaluation design for Asians.The systematic overall design concept and simple “Dr.Cui future未來” design and assessment method,it can help doctors to get a good work.

In a nutshell,An asian person's beauty and aging are mainly reflected in the Chinese two words “future未來”.and these Chinese two characters “未來” consist of the following lines。

The first horizontal line passes the arch of the brow an the temporal region.

The second horizontal line passes through the “apple muscle”.

The middle line passes through forehead、 glabella complex、 nose、lip、chin.and the other two oblique lines along the nasolabial folds,and plus teartrough,two points.Those are two Chinese characters “未來”，Englishi means “Future”.That's a good meaning.

“未來”design include the important aesthetic points and lines of the facial outline.Include the principle of formal aesthetic and include the core meaning of facial aging and beauty。(Figure 1-3).

Fig.1-3

Dr.Cui “future未來”design method introduction:At the first,the middle line,It's very important line from middle forehead.Glabella complex、nose、lips and chin.this middle line determines the symmetry、balance、coordination、proportion、stereo、light and shadow on both sides of the face.If we improve the middle line imagine,we will get 50 scores out of 100.

The second horizontal line.from temper region、eyebrow、glabella complex,this line is also very important.

another horizontal line cross cheek bone called “apple muscle”.If we fill in the inside of this line,we can visually fell the cheekbone narrowing.It is good for reducing the width of the cheekbones in Asians.

The other two lines are naso-labial folds,resolve this problem.the patient will become younger.And another two short line are the tear trough.All these lines will make up the word “未來”of Chinese characters .therefore the words Chinese characters“未來”are the core of Chinese facial aesthetics!

The aging is mainly the relaxation and ptosis of the skin and soft tissue,the displacement of the tissue structure,the appearance of skin folds,changes in the texture of the skin,and the lack of capacity.These are also reflected in the words Chinese characters“未來”.

especially,the middle line composed of forehead,eyebrow,nose,lip and chin,it determines the three-dimensional,symmetrical,balanced,and light and shade of a person's face,so it is very important to get a good mid-line.The horizontal lines of the eyebrow bow and the horizontal line of the “Apple muscle”,are also important outlines and aging criteria.The deepening of the tear trough and nasolabil folds are also important manifestations of aging.

Material and Methods

femal,48age,According to the facial overall design concept and the “Dr.Cui未來” design method,the overall creation of the work.

injection filler

Injection midline “”:glabella complex hyaluronic acid 1ml，sharp needle injection touch bone,withdraw no blood,push slowly.massage while injecting.Nose 1ml,entry point on the tip of nose,1% lidocaine local anaesthesia，use 23G blunt ; Lips 0.4 ml,use 30G sharp needle; Chin 1ml,.use 27-30G sharp needle,injection touch bone.

The first horizontal line“|”,Eyebrow 0.6 ml,use 23G blunt needle,entry point in the eyebrow tail blunt needle in subcutaneous .and temporal 2ml.use sharp needle injection touch bone,withdraw no blood,push slowly.massage while injecting.

the second horizontal line “--”,Apple muscle 1ml.Tear trough “-- ”0.3ml.

The nasolabial folds“/ ” 2ml.

About apple muscle and tear trough and nasolabial folds injection，the entry point located 1.5 cm from the outer corner of the mouth,we can use 23G blunt needle,it can reach apple muscle and tear trough and nasolabial folds.

2,fiber laser to dissolving eye bags fat .

3,radiofrequency to tight the skin of the lateral of corner of the mouth and mandibular margin.

4,A change in hairstyle

Results

Through the comprehensive use of various means,according to the “未來” design method,the face ratio of the case is harmonious,the structure is three-dimensional,the contrast between light and darkness is clear,the skin is loose and drooping is improved,the eye bags are flattened,the eyebrows are rounded and full.The eyes become spiritual,the Apple muscles become round,the visual cheekbones become narrow,the nasolabial folds become shallow and round,the nose is stereo and natural,and the ratio with the face is harmonious,and the length,convex,and radians of the chin are improved.The entire facial image shows a young and beautiful state (Figure 1-4).

Fig.1-4

Conclusion

The Chinese characters “未來” design methods is the most appropriate method of facial aesthetic evaluation for Asians.Dr.cui has more than 10,000 cases of treatment experience,and has rich experience in teaching and training.this method easy to master for doctors,safe and convenient .In brief,Master the word “未來future”,we doctors will have a good future,medical institutions will have a good future,patients will have a better future.

Section IV Three levels of Facial injection beauty

The three levels doctors:

The first level,the doctors can use various products and equipments,and master basic injection techniques and basic anatomy,to solve basic problems.The Second level,Has rich clinical experience,skilled in different parts of the facial injection,effective prevention and management of complications.The third level,regards injection beauty as the artistic creation under the condition of medical restrictions,to explore and creat the individual beauty of the patient .

Section V How to prevent and resolve complications

In recent years,Filler injection has been very popular by doctors and patients.According to statistics,Filler injection is more than 60% of the total amount of cosmetic surgery treatment.Complications also occur.Common complications include infection,mass,allergy,overfilling,embolism,etc.

Infection and allergy need to be treated according to routine symptoms.Three main groups of adverse effects induced by HA-based fillers are treated by hyaluronidase:overcorrection or superficial HA implantation,inflammatory or noninflammatory nodules,and local or remote vascular occlusions.These groups differ in the pathogenesis,clinical presentation,intensity,and possible sequela and thus require different therapeutic approach.

Despite no evidence of added benefits,some physicians added lidocaine to dilute hyaluronidase to facilitate vasodilatation.To treat overcorrection,superficial HA implantation or inflammatory reaction,hyaluronidase is delivered to the skin and subcutaneous tissue by direct infiltration of the visible or palpable mass of HA.Massage is recommended to mechanically mix the enzyme with the HA and promote filler degradation.In case of vascular obstruction by HA,whether local or remote,theoretically the enzyme has to be delivered directly into the occluded vessel.Practically,the odds to inject the same artery again are very challenging and probably unrealistic in most cases.According to the consensus recommendations,in the ischemic area with violaceous,blanchor reticulate discoloration,we can inject hyaluronidase every 3 to 4 cm,and then give it a massage thoroughly.If no improvement is observed within 60 minutes,additional 1 to 2 injection cycles are performed.More than anything，prevention is the best way to treat complications.